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Cardiorespiratory 2 > Myocardial infraction > Flashcards

Myocardial infraction Flashcards

1
Q

what is the diagnostic criteria for MI

A

Rise and/or fall of troponin with at least one value >99th percentile of the URL, plus at least one of the following:

  • Symptoms of ischemia
  • New ST segment or T wave changes or new left bundle branch block on ECG
  • Development of pathological Q waves on ECG
  • Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
  • Identification of an intracoronary thrombus by angiography
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2
Q

what is troponin

A
  • this is an intracellular proteins that is found in the intracellular cardiac myocytes
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3
Q

how is troponin used as a diagnostic criteria for MI

A
  • most of the proteins that leak out of a cardiomyocyte have absolutely no value as they could be from anywhere but troponin are only found in cardiomycoytes I and T which demonstrates death of Cardiomycocytes
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4
Q

describe an NSTEMI

A
  • Ruptured coronary plaque with subocclsuvie thrombus

- ECG non diagsnotic

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5
Q

describe a STEMI

A
  • Ruptured coronary plaque with occlusive thrombus

- ECG diagnostic

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6
Q

define the types of AMI

  • Type 1
  • type 2
  • type 3
  • type 4a
  • type 4b
  • type 5
A
  • Type 1 - spontaneous AMI due to plaque rupture
  • type 2 - ischaemic imbalance, due to coronary spasm, embolism, dissection, hypotension
  • type 3 - cardiac death duet a presumed AMI
  • type 4a - related to PCI - greater than 5 times URL for troponin
  • type 4b - caused by stent thrombosis
  • type 5 - related to CABG - greater that 10 times URL for troponin
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7
Q

what are the consequences of an AMI injury

A
  • coronary artery disease can cause regional problems

- cardiomyopathies can cause global problems

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8
Q

what are the clinical signs for ischemic myocardial injury

A 
–	Chest pain
–	 4th heart sound
–	 Low grade fever
–	 Leucocytosis and raised inflammatory markers (ESR, CRP)
–	 Troponin leak
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9
Q

why do 33% of people who have an AMI die before they reach hospital

A
  • Delay in calling for help is characterstic of
  • Older people
  • Nocturnal or weekend pain
  • No previous AMI
  • People with diabetes
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10
Q

what clot buster drugs restore flow to the heart muscle the best

A
  • SK and asprin works the best and reduces the death the most
  • Asprin reduces death and SK reduces it even more
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11
Q

treatment for a STEMI

A
  • catheters and stents straight away
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12
Q

when putting a stent in what drugs do you get

A
  • Asprin and ticagrelor
  • Heparin
  • PPCI
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13
Q

With an NSTEMI you don’t…

A
  • Don’t have to go to the cath lab straight away
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14
Q

what is the drug treatment for an NSTEMI

A
  • Aspirin and ticagrelor
  • ± GP IIb/IIIa inhibitor
  • Fondaparinux (factor Xa inhibitor)
  • Anti-ischaemic drugs (BB, nitrates)
  • Angiography ± PCI within 24-96 hrs
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15
Q

what is secondary prevention

A
  • prevention for saving lives after discharge from hospital
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16
Q

how should someone change there lifestyle after an AMI

A
  • smoking
  • diet
  • Exercise
  • Go to coronary rehabilitation courses
17
Q

what are 2nd degree prevention drugs

A 
aspirin
•	 ticagrelor/prasugrel
•	 statin
•	 beta-blocker
•	 ACE-I
18
Q

what are 2nd degree prevention devices

A

• ICD

19
Q

treatment is for life except for…

A

Treatment is for life expect ticagrelor and prasugrel

20
Q

when is ventricular fibrillation greatest risk

A
  • Risk is greatest for this in the first minutes and hours after an coronary attack
  • A number of patietns can have late ventricular fibrillation after 24 horus onset of AMI
21
Q

why is late Ventricular fibrillation a big problem

A
  • LV ejection fraction is less than 35%
  • Go into late VF if you have a big infarct
  • A defibrillator is in if there is a late VF
22
Q

what are life saving strategies in an AMI

A
  1. Prevent pre-hospital death from 1° VF
     get the patient to a defibrillator ASAP
  2. Prevent hospital death from heart failure
     initiate reperfusion therapy ASAP
  3. Prevent late deaths from
    a) Recurrent ischaemic events
     2° prevention therapy
    b) Lethal arrhythmias
     implantable defibrillator

Cardiorespiratory 2 (43 decks)

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